Clinical Features of Ocular Sarcoidosis in Patients with Biopsy-proven Pulmonary Sarcoidosis in Serbia.

PURPOSE: To analyze clinical characteristics of ocular sarcoidosis in a group of biopsy-proven sarcoid patients treated at the single referral center for sarcoidosis in Serbia. METHODS: A prospective study carried out on 88 biopsy-proven sarcoid patients between January 2012 and December 2014. All patients underwent complete ophthalmological examination. RESULTS: Ocular sarcoidosis was present in 32 patients (36.4% of all) and included: eyelid skin lesions (2.3%); orbital inflammation (2.3%); conjunctival lesions (7.9%); anterior uveitis (2.3%); intermediate uveitis (1.1%); posterior uveitis (15.9%); panuveitis (5.7%), and neuro-ophthalmologic manifestations (9.1%). Complications included cataract (20.4%); glaucoma (5.7%); cystoid macular edema (3.4%); epiretinal membrane formation (4.5%); macular atrophy (2.3%); and choroidal neovascularization (1.1%). Binocular visual impairment was present in one patient (1.1%), due to complications of posterior uveitis (macular scars). CONCLUSIONS: Patients in Serbia demonstrated ocular sarcoidosis as the first most common site of extrapulmonary sarcoid manifestations, with more often neuro-ophthalmologic lesions than in other European populations.

Lamotrigine augmentation in delirium tremens.

INTRODUCTION: Delirium tremens (DT) is most severe neurological complication of alcohol withdrawal with high mortality rate. DT is related to an altered balance of excitatory and inhibitory amino-acid neurotransmitters, which is basically due to upregulation of glutaminergic neurotransmission induced by chronic ethanol exposure. Lamotrigine (LTG) is believed to act by reducing excitatory glutamate release due to inhibition of Na (+) channels. OBJECTIVE: The aim of this study was to investigate efficiency of the LTG therapy in the treatment of delirium tremens. METHODS: This prospective clinical study included 240 patients with ICD-10 criteria for DT, who were randomly divided into control and experimental group. The patients were observed within 28 days at the Intensive Care Unit of the Centre for Urgent Psychiatric disorders, according to a specific protocol, which included CIWA-Ar and MDAS clinical scales. Control and experimental group were treated according to the NIAAA protocol for 2004, and experimental group with adding of LTG according to a specific program. RESULTS: CIWA and MDAS scores in the experimental and control group has statistical significant differences after the third day (p > 0.1), and especially after the fifth day (ECIWA5/KCIWA5 = 8.36 +/- 6.782/32 +/- 5.562; EMDAS5/KMDAS5 = 4.89 +/- 3.408/26.33 +/- 1.497) (p > 0.5). CONCLUSION: LTG is significantly efficient in the treatment of delirium tremens, but it does not decrease mortality rate.

[Varicella complications: is it time to consider a routine varicella vaccination?].

BACKGROUND/AIM: Varicella is a common and benign disease of childhood. Complications are rare, but in some patients, even without risk factors, severe, life treathening complications could be seen. The aim of this study was to establish the type and frequency of varicella complications among hospitalised patients over an 8-year period. METHODS: This retrospective analysis included medical charts of the patients hospitalised in the Infectious Disease Clinic, Belgrade, Serbia, from 2001-2008 (4.85% of all registered patients with varicella in Belgrade, 2001-2008). Among hospitalised patients dermografic characteristics were analysed: hospitalisation lenght, presence and type of complications, presence of immunocompromising conditions and outcome of the disease. The diagnosis of varicella was made on clinical grounds, and in persons >40 years, with negative epidemiological data of contacts, serological confirmation (ELISA VZV IgM/IgG BioRad) and avidity of IgG antibodies were done to exclude the possibility of disseminated herpes zoster. RESULTS: A total of 474 patient were hospitalised over an 8-year period. The age of patients was from 5 months to 75 years (mean 22.4 +/- 16.1, median 23.5 years). The majority of patients were adults (n=279; 58.9%) and 195 (41.1%) patients were < or =15 years old. Complications were found in 321/474 (67.7%) patients. The registered complications were: varicella pneumonia (n=198; 41.38%), bacterial skin infections (n=40; 8.4%), cerebelitis (n=28; 5.9%), bacterial respiratory infection (n=21; 4.4%), viral meningitis (n=10; 2.31%), encephalitis (n=9; 1.9%), thrombocytopenia (n=2; 0.4%); 11 (2.3%) patients had more than one complication, among them were sepsis, myopericarditis and retinal hemorrhages. When complications were analysed according to the age, there were no statistical significance, but when type of complication was analysed statistical significance was found (p < 0.05). In adults, pneumonia was the most common complication: 173/279 (62%), followed by skin infections (2.9%), bacterial respiratory infections (2.2%), and more than one complication (2.3%). Pneumonia was more common in adults than in children (7:1). In children skin infections were the most common complications (16.4%), followed by cerebelitis (13.3%), viral pneumonia (12.8%), bacterial respiratory infections (7.7%), encephalitis (3.6%), and more than one complication (4.1%). Neuroinfections were more common in children than in adults (6:1), as well as bacterial skin infections (4:1). Two patients died (0.4%). CONCLUSION: There was no difference in the incidence of varicella complication in children and adults, but the type of complication differed. In children the most common complications were skin and neurological infections, while in adults it was varicella pneumonia. These data provide a baseline for estimating the burden of varicella in Belgrade and support the inclusion of varicella vaccine in childhood immunisation program in Serbia.

[Arterial hypertension frequency in urban and rural population of children].

The principle objective of this investigation was to establish the frequency and form of the arterial hypertension in children between 7 and 16 years in urban and rural population. Specific goals were to determine by screening method, i.e., by elimination, the arterial hypertension prevalence in relation to permanent residence (town-village), age and sex of children; to determine, by the same method, the prevalence of the essential and borderline arterial hypertension; to test the risk factors in patients with essential and borderline arterial hypertension: obesity, hereditary predisposition (relatives of the first and second line), lipids, and ten-year follow-up of children with essential arterial hypertension. The examination included 3000 children (age 7-16 years) during regular school days. Essential arterial hypertension in this study was defined as blood pressure continuously higher than 95th percentile for age and sex in at least three different measurements; secondary causes of hypertension were excluded by available clinical, laboratory and functional investigations. Borderline hypertension was defined as blood pressure continually higher than 90th percentile, and from time to time higher than 95th percentile for age and sex in at least three measurements, when the secondary causes of hypertension were excluded. The obtained results were the basis for the following conclusions: Prevalence of arterial hypertension for all children was 0.93% and was the lowest in children aged 7-8 years (0.83%), and the highest in chil dren aged 15-16 years (2.96%). Prevalence of the essential arterial hypertension was 0.37% and of borderline arterial hypertension 0.56%. Prevalence of the arterial hypertension was higher in urban than in rural population of children (1.09:0.55%), but without statistically significant difference (p>0.05). Hypertension was verified in 60.7% of family members of children with increased blood pressure. 21.4% of hypertensive children were overweight. Hyperlipidemia was noted in 4 children with essential hypertension. All children with arterial hypertension underwent 24-hours Holter monitoring. Patients with essential arterial hypertension had sinus tachycardia in 95% and patients with borderline hypertension in 60% (in stress and pressure).